Cause and Effect Apps to Help Individuals with Severe Cognitive and Communicative Challenges

(This post is reprinted from the Innovative Technology Treatment Solutions Newsletter dated 12/20/13)

Over the past several months I have been asked by quite a few families, therapists and advocates to evaluate students with severe cognitive and communicative challenges and try to figure out if there is anything else that can be done to help these children and young adults access the curriculum and improve communication. Typically I am consulted because people want to explore the potential of using the iPad to help these individuals who are making very little, if any, progress in their current educational setting despite many years of intervention. They are unable to show what they know or express themselves.

These situations are very challenging. The individuals I am asked to evaluate and help often:

do not have a functional pointing response,
do not reliably gesture
have an unreliable yes/no response and
do not appear to pay attention to structured activities.

Families and educators typically have a hard time finding external sources of motivation. Some of these students have been diagnosed with severe autism spectrum disorder while others are labeled with profound intellectual disability.

By the time I am in the process, many of these students have already been exposed to approaches using the following approaches:

These approaches are highly effective with many people, but not the ones I am thinking about as I write this. I am consulted to try something new- the iPad. It does not work miracles- but it can be a helpful tool in engaging others and creating joint attention, environmental awareness and focus which is often where therapy needs to start.

Suggestions to try:

Generate interest– I have found it helpful to first try to pique their curiosity about the iPad before directly asking them to do anything with it. Many individuals have never seen or touched one. After observing the child or young adult and speaking to their teachers and families to get a sense of their interests and capabilities, I start by sitting beside them and using some of the cause and effect apps. This action typically generates interest for others in the room and I encourage others to try using the apps on my iPad. They touch the screen and see something happen. Sometimes this helps the person I am there for become interested in the iPad and these apps and they are more willing to try. On other occasions I need to take a totally different approach and work alone with the individual in a room free from other sights and sounds.
Figure out the best selection method- Once the person starts paying attention to the apps I help them use the appropriate gestures- touching, tapping, swiping or producing voice/sound. I observe the motion that seems easiest for people. Some can touch and release well, others are better at sliding their finger. On one occasion I asked a teacher to put a glove on a student with the pointer finger cut out so that the iPad would only respond to the touch of that part of the finger.
Prevent the individual from exiting the app– I use the guided access mode of the latest iPad operating system (ios6) so that we don’t exit the app prematurely. It’s easy to do. Barbara Fernandez is a speech pathologist and avid app developer (over 36 apps!) (Smarty Ears Apps) who published a short video about using guided access. Click here to view.

Here are some of the thoughts I have in mind as I select apps:

Access– What type of movement do I want to try? Am I going for a gross movement or interaction where they can touch the screen anywhere or do I want isolated single finger control which may be needed for an AAC app? Does the app require a tapping or sliding motion? Am I trying to elicit verbal sounds?
Motivating response– What kind of response is motivating for this individual? Some apps have calm music while others offer exciting music; some apps have very busy exciting visuals while others use simple easy to see visuals.
Content– What is appropriate content to match the individual’s age?

Below is a list of apps with integrated links that I have successfully used for developing interaction and joint attention.

Repeated exposure may be needed to achieve results.
I usually work with each person at least 3 times for my assessment process.

All of the apps listed are available for iPad

Some will not work on an iPhone.
I noted the ones that are also available for other operating systems.
Most of these apps I chose have movement, are highly visual and provide sound/music to engage their users.
When possible, links to the developer’s website are provided for each app.

Ilovefireworks by Fireworks Games

Kaleidoscope Drawing Pad by Bejoy Mobile ios, Android, Blackberry

Cause and Effect Sensory Light Box by Cognable ios and Android

Make it Pop! by Tryangle Labs ios

Injini Child 1 cfDevelopment Suite by NC Soft ios

Peekaboo Barn by Night and Day Studios ios and Android

by Ellie’s Games LLC ios and Android

Random Touch by Joe Scrivens

Fluidity by nebulus design ios and Android

Music Sparkles by Kids Games Club ios

Pocket Pond by TriggerWave LLC ios and Android

Music Color by SoundTouch ios